Its funny how something we consider best practice will often be replaced by something we previously considered worst practice.
In a new study of 600 patients published in the Lancet, a below knee cast has been found to be more effective than a compression bandage in the management of sprained ankle.
In fact, a tubular compression bandage, combined with ice, elevation and advice to mobilize as soon as possible (which is pretty much current practice), was consistently found to be the worst treatment of all those examined.
Instead, a 10-day below-knee cast was associated with a speedier recovery in terms of ankle function, pain, symptoms and activity three months later.
John Heyworth, president of the College of Emergency Medicine, was quoted by the BBC as stating the study was:
“…practice-changing, high quality research”.
“What we do with these common problems, is we look for the best evidence and up until this paper, the evidence suggested that early mobility provided a better outcome and this provides some good evidence that immobilisation can provide greater benefits.”
Dr Martin Shalley, A&E consultant at Birmingham Heartlands Hospital, said they tried to avoid immobilising the ankle because of the risk of deep vein thrombosis.
“That has to be balanced and we can discuss the pros and cons with the patient and work out the best treatment programme for them.”
Unfortunately for the nursing/medicalÂ staff, the correct application of a below knee plaster1 on all these sprained ankles will be considerably more time consuming than a simple tubi-grip bandage.
[photos credit: Daniel Paquet]
- this would include patient education, and a follow-up check to make sure the plaster was not too tight due to further swelling [↩]